SHBP Protest Groups Misguided

Georgia SHBP protest groups are misinformed and misguided. Teachers Rally Against Group Insurance Changes shbp protest(T.R.A.G.I.C.) formed a Facebook group in early January to express their frustration in changes to the GA State Health Benefit Plan. Obamacare is at the root of their complaints, but they refuse to concede this point and would rather direct their efforts toward the governor’s office.

Members and supporters of SHBP protest groups are certainly vocal but completely misguided in their efforts. They have not connected the dots between changes in the SHBP and Obamacare. TRAGIC and their supporters also fail to accept responsibility for the choices they made during last falls open enrollment.

  • The 2013 SHBP package was not ACA compliant
  • SHBP 2014 was required to be updated to meet Obamacare mandates
  • SHBP fall open enrollment clearly outlined benefit changes for 2014
  • Covered participants of SHBP had a choice of accepting the change or purchasing coverage in the open market

My wife and I are covered under the SHBP. We were given handouts at employee meetings and links to the state website where SHBP plan options were delineated. Yet no one complained at that time. SHBP protest groups did not spring up until AFTER the benefits were active on January 1, 2014.

Did they fail to read the handouts or visit the choices site?

One must assume the whiners never bothered to study the plans and weigh options outside the SHBP. The plan cannot be changed at this point. There is no going back. The Obamacare plans are not popular among individuals who have tried to use the exchange which is part of the reason why enrollment goals have not been met. For the 2 million or so that have selected a plan, estimates that 60 – 80% have yet to pay their first premium.

Over 65 million visitors to but only 2 million have “signed up” for a plan they are required by law to have. Perhaps fewer than 500,000 have paid for their purchase.

Had the SHBP protest groups followed a similar process and studied the plans many of them may have refused to accept the plan designs and sought other coverage.

But they didn’t.

SHBP covered participants don’t get a Mulligan. Barring a Special Election Period because of a qualifying event, they will need to learn to live with their choice.

We reviewed the plans during open enrollment. We understood there were changes. Premiums were higher. Benefits were lower. Higher deductibles and more out of pocket.

We also considered our health care needs, our budget and looked at options OFF the exchange. (Most SHBP plan participants are not eligible for a subsidy so exchange plans should not even be a consideration).

So what can you do if you are in the SHBP to minimize your cost for health care?

  • Maximize your HRA dollars and go through the wellness steps at BeWell
  • If you have not read your plan, do it now.
  • Go to the BCBSGA/shbp site and look up everyone of your providers.
  • Print it out, especially participating urgent care facilities
  • Register with Express Scripts. Look up all your meds
  • Consider changing to generics
  • Evaluate 90 day mail order options
  • Consider ordering from a Canadian pharmacy such as Blue Sky

Rather than treating your health insurance plan like an “all you can eat” buffet, learn to manage your dollars. The sooner you master this skill the better off you will be. The current plan design is the future of health insurance. Protest groups like TRAGIC will not be able to roll back the calendar to the old days so get over yourself. If you spent as much time educating your members on ways to save money on health care everyone would be better off.

Many chronic health conditions can be effectively managed with a healthier lifestyle. Diet and exercise can do wonders for hypertension, high cholesterol, back pain and type II diabetes.

You can change the way you manage and pay for your health care, or you can join a Georgia SHBP protest group and be miserable. Your choice.

Obamacare 2014 – What Happens Next?

Obamacare 2014 finally sputtered out of the gate and we are 13 days into a new way of doing things. What next? If you don’t like your new plan, can you change? Did you lose your doctor(s) in the transition? Is the obamacare 2014premium affordable but the deductible too high? Did the plan you get match what you thought you were buying? Do you feel like Private Benjamin (Goldie Hawn)? “I did join the army, but I joined a different army. I joined the one with the condo’s and private rooms”.

First the good news. For now at least, you are not “married” to your Obamacare 2014 plan. You can still make a change and live to see another day.


Can my Obamacare 2014 plan be returned for a different model?

In most cases yes. In some situations it takes 10 minutes. But if you bought on the exchange and you want a DIFFERENT subsidized plan the answer is, forget it. You may be able to exchange one subsidized plan for another but getting there won’t be easy or a lot of fun.

Moving from a subsidized plan to one OFF the exchange (no subsidy) should be simple. Moving from a non-exchange plan to another non-exchange plan can be accomplished in 10 minutes.


Why would I want to change my 2014 Obamacare plan?

Many reasons.

Maybe you just came out of the ether are realized the plan you bought has no copay’s and you have to fund the first $6000 or more before the plan pays. Or you bought a plan with an HMO network and there is only one hospital in the network. If you bought a Blue Cross plan (on or off the exchange) and thought “Everyone takes Blue Cross” you need to understand about 70% of the docs and many hospitals in the Blue HMO are not included in your plan.

We have several carriers and plans off the exchange that may be a better fit for you. One 2014 Obamacare plan that is only available outside the exchange limits your out of pocket expenses to $950 per year. If you are one that will be using their plan a lot you really should consider this one. We have several people that use over $1000 per month in prescription drugs and this plan is a perfect fit. After January they will never have to pay for another Rx or doctor visit.

What a country!

We will be glad to discuss options or you can go through the drive through and use our free and easy quote engine to shop and compare rates at ACA Health Insurance Georgia.


Did you lose your doctor(s)?

It happens. Many doctors are not participating in Obamacare 2014 and especially if you bought on the exchange. But there is a wide range of options outside the exchange and most of these plans (except Blue Cross) have most of the doctors and hospitals in Georgia. Even if you wander into a doctors office that is not in network you still have coverage for most non-emergency care situations.

If you did lose your doctor because you signed up for an HMO it is not too late to get back into a PPO. Shop and compare!


Can’t afford your high deductible?

High deductible plans are great as long as you are in good health. But if you normally use your plan a lot, with doctor bills, hospital stays and high prescription drug costs you may actually come out ahead with a lower deductible plan.

We have plans off the exchange with $0 deductibles, $950 and $1000 deductibles. It is so fast and easy to shop and compare plans and rates on ACA health insurance.


Did you get what you wanted and needed?

If your Obamacare 2014 plan isn’t a good fit exchange it now before it is too late. You only have a few weeks left to still get a 2014 Obamacare plan that works the way you need it to.

Georgia Hospital Closing

Calhoun Memorial Hospital is closing. The loss of this Georgia hospital is a combination of the failing economy and financial strain caused by uninsured patients and increased number of Medicaid patients.

A handful of other rural hospitals in the state also may be teetering on the brink, with rising levels of uninsured patients and with Medicaid continuing to pay low rates for services.

HomeTown Health, an organization of rural hospitals in Georgia, says a half-dozen facilities could follow Calhoun Memorial’s move and shut down in the coming months.

Georgia Health News

Providers that accept Medicaid patients receive roughly 20% less than Medicare pays for the same services and Medicare pays about 15% less than private insurance carriers. With more patients relying on Medicaid doctors and hospitals feel the squeeze and have to take action.

Hospitals that accept any kind of federal funds cannot refuse Medicaid patients but doctors and other medical providers are not obligated to treat Medicaid patients.

The 25-bed “critical access’’ Calhoun Memorial is the first rural Georgia hospital to close since Telfair Regional Hospital in McRae, in south-central Georgia, closed in 2008, Lewis said Monday.

Earl Whiteley, CEO of Calhoun Memorial, cited the increase in charity care that the Calhoun County hospital incurred as a major reason for the hospital’s demise.

He told GHN on Monday that indigent charity care rose from $834,000 in 2008 to $1.8 million last year.

“You just can’t continue to give away free care,’’ Whiteley said.

Tell that to the low information voters that gave Obama another 4 years.

Whitley said part of the financial crisis is due to the loss of indigent care funds under Obamacare. Those patients were supposed to be covered under Medicaid expansion but Georgia, like most other states, do not have the money to pay their share of the cost of Medicaid.

Prior to Friday’s action, the Calhoun hospital authority had sold an assisted living facility and its nursing home. The hospital had stopped admitting patients, so there were none left to transfer to other hospitals. A medical clinic will remain open in Arlington, Whiteley said.

The economic impact on Arlington and Calhoun County will be profound, with up to 100 employees losing jobs.

With the closing of this Georgia hospital, local residents will have to drive about 45 minutes to the nearest hospital.

Obamacare Insurance Exchange

If you can’t wait until the Obamacare Insurance Exchange is up an running you might be very disappointed. It has been painted as a streamlined market place where online shoppers can view plans, provisions and rates and pick the best plan.

Sounds great, doesn’t it?

The truth is, the Obamacare insurance exchange may never materialize, complete with taxpayer subsidies, and if it does come to be it probably won’t be anything like you have imagined.

Like paying taxes, buying insurance is a complicated proposition, rife with jargon and high stakes: Errors can cost big money and run afoul of the law.

And like doing taxes, buying a policy on the exchange means interfacing with state and federal government agencies, too.

Kaiser Health News

After more than 37 years in the health insurance business, working in many capacities and now the last few years dealing with Medicare on behalf of my clients, I can tell you that the only thing worse than trying to get help from an insurance carrier is getting a straight answer from the government.

Like the bumper sticker says, “If you like the U. S. Post Office you will LOVE government health care“.

 Jargon is a big issue for consumers, who want to be able to hover a mouse over confusing terms to get a quick explanation of something they need to know, a popular feature of the tax software.

The insight comes from discussion groups convened last summer by three Colorado nonprofits. The groups found 414 people in eight urban and rural locations to help the state’s exchange board understand what people are going to need to shop on the exchange. Participants were volunteers, not scientifically selected, but organizers said their demographics roughly match those of anticipated exchange users.

The feedback tells exchange planners that they have a high mountain to climb. Consumers said they know very little about insurance and will need a lot of customer support to use the exchange.

Isn’t it a shame the Obamacare insurance exchange will all but eliminate the role of the insurance agent, many of whom have spent years learning their trade and assisting clients in finding the right plan that meets their needs and budget? Instead of relying on experienced agents, consumers will have to hope that “Suzie” is available to answer their questions and has learned enough from her 2 week training course to offer real advice and assistance.

More than half in the discussion group were under 30 years old. When asked “who helps you choose a health plan now?” 215 said “parents,” and 105 said a family member. Only 17 said they turned to the Internet for help picking a health plan now, fewer than named brokers/agents (22), employers (45) or “myself/nobody” (44).

That’s a real vote of no confidence for this process going forward.

RomneyCare, the Untold Story

RomneyCare is the model for Obamacare, but is the Massachusetts experiment in universal health care REALLY what Gov. Mitt Romney wanted? Not even close. Governor Romney fully supported RomneyCare? Nope, wrong again. President Romney would support RomneyCare as his version of Obamacare. In some ways, yes, but in others, no.

Avik Roy penned an article for Forbes revealing some of the not-so-well-known stories about the passage of RomneyCare.

When Romney stepped onto that stage on April 12, 2006, he received a 30-second ovation. Behind him stood Sen. Ted Kennedy, his 1994 opponent for the U.S. Senate, and Democratic leaders of the Massachusetts legislature. George W. Bush’s Secretary of Health and Human Services, Tommy Thompson, was there. “Massachusetts is showing us a better way,” Thompson said, “one I hope policymakers in statehouses and Congress will follow to build a healthier and stronger America.”

But the bipartisan bliss didn’t last very long. Just prior to the ceremony, Romney’s aides had announced that the Governor would be vetoing several key provisions of the bill, including its employer mandate that forced all companies in the state, employing more than 10 people, to provide health coverage for their workers or pay a $295-per-person fine. Romney vetoed several other provisions of the law, including one that extended dental benefits to Medicaid patients, and another that gave certain “special status aliens” the ability to receive Medicaid benefits.

Vetoing key provisions of RomneyCare? Why has this truth been hiding under a basket?

In the end, it didn’t matter what Romney thought about the employer mandate. The Democrats controlled 85 percent of the legislature. After the bill-signing ceremony was over, they went back to the State House and overrode each of Romney’s eight vetoes.

So what Romney wanted in RomneyCare was NOT what Romney got.

it was Democrats and progressive activists who ended up implementing the Massachusetts health law, especially after Romney left office in January 2007. They took the law in a much different direction than Romney would have liked. And while Democrats have sought to credit (or blame) Romney for the passage of Obamacare, it is more accurate to say that the federal Affordable Care Act is modeled after the Democratically implemented version of the Massachusetts law, as opposed to the one that Romney had sought.

RomneyCare is really a socialist DemoCare Frankenstein monster.

RomneyCare actually is an evolutionary process set in place by years of government "reforms" that mostly served to make health care, and health insurance, more costly.

In 1996, the state legislature passed the Non-Group Health Insurance Reform Act, which forced insurers in the individual market to cover everyone, irrespective of pre-existing conditions (“guaranteed issue”), and charge nearly-equal rates to the young and the old (“community rating”).

Because these reforms allowed individuals to remain uninsured until they were sick, premiums shot up for those who tried to be responsible, and buy coverage for themselves when they were healthy. (Those who received insurance through their employers were not directly affected.) More and more individuals sought free care from emergency rooms, rather than buy costly insurance that they couldn’t afford. Insurers dropped out of the market. Things got so bad that even, the on-line insurance broker, dropped out of the state, citing the guaranteed-issue provision.

And this my friends, is why RomneyCare, and its' evil twin sister Obamacare, doesn't work so well. RomneyCare could have removed guaranteed issue and community rating, and doing so would have made it a more workable and affordable plan.

But it didn't.

Massachusetts was a state in crisis over health care funding. Their Medicaid program was in the hole and in danger of losing $385 million in federal tax dollars unless something changed. That change would be RomneyCare, but the plan as originally conceived, not the one passed by the Democrat controlled state legislature.

“Insurers tell us they can develop plans costing less than half of today’s standard rate of $500 for an individual,” Romney wrote. Shorn of the costly mandates and restrictions originating in earlier state laws, these plans, called “Commonwealth Care Basic,” could cost much less.

This was the basis for RomneyCare, but the final version did not look anything like what was on the drawing board.

Romney’s goal, with the individual mandate, was to require people to buy catastrophic insurance that would cover emergency care. Romney’s version of the mandate was designed to compensate for the effects of the federal EMTALA law, that requires hospitals to provide emergency care to everyone, regardless of their ability to pay. “Therefore,” writes Archambault, “the original 2005 legislation filed by Governor Romney required that Massachusetts residents carry, at a minimum, catastrophic medical coverage, or in lieu of such coverage, a $10,000 bond…an approach that tracked the Commonwealth’s requirement for automobile insurance coverage.”

However, the bill that emerged out of the Democratic legislature contained a different mandate.

Gov. Romney's idea for RomneyCare was not only workable, but showed incredible insight in to the problems of the uninsured.

What he finally got bore no resemblance whatsoever to his original RomneyCare plan. Why has this story never seen the light of day, and why hasn't Mr. Romney used this in his bid for the presidency?

Obamacare Union Payoff?

Was the real purpose of Obamacare to pay off unions for their support? Some believe that and with good reason. When you look at the number of exemptions and see that a significant number are for union groups you have to wonder.

Now comes this report on ERRP.

InsureBlog has posted a scathing expose' on how taxpayer money was used to fund union health insurance plans.

Read ERRP – We Had to Pass the Bill so you can find out what is in it.

Washington Needs Your Medical Records

Washington wants your private medical history. Don't worry. It is for the good of the people. Your records will not be used against you. After all, this is Washington and everyone knows they can keep a secret.

The folks in DC want to save Medicare. This will be accomplished with major surgery. Your doctor will be paid less, but so what? He earns more than you and can afford to take a pay cut, right?

Some medical services may no longer be paid for by Medicare, but no big deal. You probably didn't really need that treatement and you have lived a long life already. Your time on this earth can't be that much longer.

Medicare cutsMedical Records No Longer Private

According to U S News the Obama administration will be requiring all doctors to submit your medical records to the government.

You don't have a problem with that do you?


HHS is making plans to get its hands on your health care records, one way or another, whether you want them to have it or not.

The department's first choice is to collect them directly. If they can't manage that, Plan B is to require the states to collect the data and take it from there. Plan C is to lean on health insurers, using a new regulatory scheme that would require private companies to crunch the data according to new federal mandates the ways the feds want it.

Does any of this bother you, or is it just me?

Been to the doctor lately? Things are different now.

This is Not Your Father's Doctor Visit . . .

A few weeks ago we were out of town and my wife became ill. I took her to a local doc in a box which was an experience in itself.

As first time visitors, she was required to complete a detailed medical history. About 10 minutes or so with a nurse, answering questions, then sign here.

No, you do not get a copy of this information. We are filing it electronically for your protection.

The entire visit took about an hour, most of that time was wait time even though we were the first ones in when the doors opened.

The entire bill for a routine exam and urinalysis was grossed up to $496. After network discounts it came to $248.

The break out was like this.

Gross charges $61 for professional visit, $40 for lab. Balance was for the medical history and establishing her account as a new patient.

Excuse me?

$395 for medical records that the patient doesn't even get to see but are transmitted to HHS.

At this rate I don't think Obamneycrap is going to save anyone any money.

How is this new government health care plan working for you?

Obamaneycare, a Giant Step Backwards

We were told that Obamacare was necessary because too many Americans were without health insurance—which is not the same thing as them being without medical care when it is needed. Rather than fix the stated problem, however, it has made things worse, even before it is fully implemented. According to some recent estimates more than 1 million Americans have lost their coverage in the period since Obamacare became law.

This is not progress.

No kidding.

Reminds me of the old saw. I am from the government and I am here to help you.

I don't think so . . .

If you think they will stop here you are wrong.

In addition to cutting Medicare benefits, they also think your Medigap coverage is too "rich" and want to cut those benefits as well.

Georgia Medicare Plans can help you find the lowest Medigap rates in your area. We have plans from Dalton to Tifton with carriers such as Aetna, Blue Cross, Humana and more. Ask for a Medigap quote today.

Piedmont Job Cuts

High unemployment and many without health insurance in Georgia lead to layoff's at Atlanta Piedmont Hospital. A combination of Obamanomics and Obamacare is putting pressure on GA health care providers.

Piedmont Healthcare cutting 5 percent of workforce




The Atlanta Journal-Constitution

8:54 p.m. Thursday, June 9, 2011

Faced with a rising number of uninsured patients and unknown impact of the new health care law, Piedmont Healthcare announced Thursday evening plans to cut 464 jobs as part of an effort to save an estimated $68 million.

Totaling roughly 5 percent of its workforce, the cuts include 171 positions that were vacant or altered because of scheduling changes. Layoffs are coming from across the board, including Piedmont’s four hospitals, physicians group, heart institute and corporate division, spokeswoman Nina Day said.

“This is heart-wrenching,” Day said. “This is not easy stuff when you’re talking about people.”

The move is, in part, a reaction to hurdles many hospitals are facing, including a growing number of uninsured patients, a new state hospital bed tax, anticipated cuts to Medicare reimbursements and the Medicaid expansion in 2014, Day said.

“We do have a positive bottom line,” she said. “We would like to keep it that way for the sake of our patients.”

The goal is to not impact services to patients, Day said, adding that while she knew of no clinical service being shutdown, some resources may be cut back in certain areas.

Changes could include areas such as food court hours, room service delivery schedules and even eliminating coffee in certain departments, she said. Piedmont also reevaluated supplies and renegotiated contracts with vendors, Day said.

Piedmont’s push to realign itself with a rapidly changing industry began several months ago. The health system began notifying employees of the cuts last month, she said.

“I think for the most part, hospitals are facing some extraordinary challenges across the board,” said Kevin Bloye, a spokesman for the Georgia Hospital Association.

Hospitals throughout the state have been forced to cut back and lay off workers over the past few years, especially in the wake of the economic downturn, Bloye said. Many people lost their jobs, increasing the number of uninsured and under-insured patients. Others put off elective surgeries, which has had a dramatic impact on hospitals’ bottom lines, he said.

While hospitals will get more insured patients as a result of the Medicaid expansion in 2014, it’s a big trade off with Medicare cuts, he said. State officials have estimated Georgia could add more than 600,000 enrollees to its Medicaid program as a result of the expansion.

“It’s a challenge in time just trying to navigate all of these changes,” he said.







Find this article at:


It's the economy stupid.







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Price Controls

Hospitals and health insurance carriers are more often foe's, not friends. But the lamb has laid down with the lion and the editor at Fierce Health Finance observed something odd and posted his observations.

Duane Dauner, head of CHA (California Hospital Association) expressed his opposition to a bill working its' way through the legislature that would reject any requests for health insurance premium increases deemed . . . "unreasonable". A law so vague means more political grandstanding than just putting an actual face on the process.

Beyond that, any attempt to institute price controls has always proven to be counter productive.

However good their intentions, price controls actually result shortages and higher prices.

Consider this. For years we had a monopoly phone company with prices regulated by the government. Once the monopoly was ended and free markets were allowed to exist consumers had more choices and lower prices.

What the government is attempting to do is end free market competition and force a price controlled monopoly on health insurance. It won't work.

So why are hospitals specifically against a bill that would limit premium increases?

hospitals in the Golden State spend about $12 billion more a year on Medicare, Medicaid and uninsured patients than they take in. They therefore need to make it up on their patients enrolled in commercial health plans. Hospitals fear that any crimping of premiums will lead to even more wrangling on rates, and exacerbate the problem.

Read that again. Hospitals in CA LOSE $12 BILLION per year on Medicare and Medicaid patients. So where do they make up the losses?

Medicare and Medicaid payments are mostly getting smaller rather than larger, creating more pressure to extract optimum revenue from commercial payers, and essentially pitting hospitals against the best financial interests of its patients.

In other words, hospitals need patients with private insurance and they need that insurance to pay more, not less, so they can continue to survive.

It won't get any better under Obamacrap since the underlying precept of the law is to fund health insurance for low income and uninsured through a combination of REDUCED payments for Medicare patients and higher taxes on everyone.

As far as I know there are no proposals in Georgia to duplicate what is happening on the left coast but it does not matter as there will be similar pressure coming from Washington to further change the way health care and health insurance is developed and those changes are not for the good.

Georgia Insurance Shop is a leading resource for information on affordable health insurance and Medicare supplement plans for GA citizens.